1386647717 NPI number — MSH PARTNERS, LLC

Table of content: (NPI 1386647717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386647717 NPI number — MSH PARTNERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MSH PARTNERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386647717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14201 DALLAS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-763-3859
Provider Business Mailing Address Fax Number:
214-443-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 E LEMMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-443-3000
Provider Business Practice Location Address Fax Number:
214-443-3049
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FLEMING
Authorized Official First Name:
DONITA
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
202-815-3665

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000008 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181378501 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HASC04228 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0210 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 19300-0006 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6540760 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HO4504223 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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